1609206457 NPI number — NORTH STAR ANESTHESIA

Table of content: (NPI 1609206457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609206457 NPI number — NORTH STAR ANESTHESIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH STAR ANESTHESIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609206457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 E. LAMAR BLVD #400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 E. LAMAR BLVD #400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-227-6884
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUDNALL
Authorized Official First Name:
COURTNEY
Authorized Official Middle Name:
KATHERINE
Authorized Official Title or Position:
NURSE ANESTHETIST
Authorized Official Telephone Number:
937-510-4516

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  15532 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)